There are a large number of injectable fillers today (nine at present) that are used exclusively for aesthetic facial purposes. Many of these are composed of hyaluronan with well known brand names such as Restylane, Juvaderm, and Perlane to name a few. The popularity of these injectable products is that hyaluronan is naturally found in many tissues of the body, such as skin, cartilage, and the vitreous humor of the eye. It is therefore extremely well tolerated when placed into the body.
Hyaluronans fundamentally differ in their concentrations and size of the molecules with longer-lasting products having bigger molecules and higher concentrations. The longest lasting and largest molecule of hyaluronan that is available as an injectable filler is not available here in the U.S. Macrolane (the manufacturer of Restylane and Perlane) is available in many countries around the world and is used for non-surgical body shaping treatments.
The concept of Macrolane is that it can naturally regenerate body contours. That is a technical way of saying it can be used in lieu of any body procedure which uses an implant. It is touted for use as a substitute of breast and pectoral implants as well as buttock and calf implants. Macrolane can also be used even out discrepancies in the skin surface, most notably liposuction irregularities or depressions. The large size of the molecule allows it to persist for longer than a year and it is very thick and viscous. (very much like injecting jello) Because the body naturally breaks down hyaluronan, any shaping will only last for 12-18 months and top-ups would be required to retain its contouring effects.
How effective is an injectable material compared to an implant? Having looked at the companies website and their before and after photos, I would have to that its effects are visible but fare poorly compared to an implant. In my Indianapolis plastic surgery practice, almost all of my patients would not have been happy with any of these results.
This does not mean that it has no role to play in body shaping. But it would take very careful selection of patients who only need more minor changes to be satisfied. While the injection procedure would not require a general anesthetic and could be done in the office, its limited improvement and lack of a permanent result make its use more narrow than one would think.
While fat injections are currently filling much of the role that Macrolane might play in the U.S., I suspect we will eventually see this injectable product available here provided its safety profile is acceptable. The problem that I see with its use in the U.S. is that it may quickly find its way into the hands of those who are not adequately trained in the scope of body contouring because of its ease of use and lower costs than a surgical implant.
Dr. Barry Eppley
Indianapolis, Indiana